Have questions about Act 1? Want to know if YOU are covered by the law? Read our FAQs below to learn more.
What is Act 1?
opens in a new windowAct 1 of 2023 eliminates all costs associated with screening breast MRI, ultrasound, genetic testing and counseling for individuals at high risk and insured under Pennsylvania law.
Am I considered “high risk?”
High-risk factors covered by Act 1 include individuals with 1 or more of these risk factors:
Screening breast MRI / Ultrasound coverage
- personal history of breast cancer
- family history of breast cancer
- personal history of abnormal breast screenings
- extremely dense breast tissue
- heterogeneously dense breast tissue + 1 additional risk factor including:
- > 20% lifetime risk of breast cancer according to risk assessment tools
- personal history of BRCA1 or BRCA2 gene mutations
- first-degree relative with a BRCA1 or BRCA2 gene mutation but not having had genetic testing herself
Genetic testing / counseling coverage
- An increased risk, based on a clinical risk assessment tool, of potentially harmful mutations in the BRCA1 or BRCA2 genes due to a personal or family history of breast or ovarian cancer
When does the law take effect?
All state-regulated insurance plans must be in place before the end of 2025, however, the law takes effect for many plans between 2024 and 2025. Please check with your insurer to see when it takes effect for you. opens in a new windowClick here for our Act 1 insurance coverage guide.opens PDF file
How do I know if this new law applies to my insurer?
Act 1 covers individuals whose insurance is state-regulated. This can include plans purchased through the Pennie marketplace or employer-provided insurance. To find out if your employer-covered plan is insured under Pennsylvania law, contact your human resources or benefits administrator. If you are insured under Pennsylvania law (if your insurer is state-regulated), you are covered under Act 1. opens in a new windowClick here for our Act 1 insurance coverage guide.opens PDF file
I need an MRI before this takes effect and I am uninsured. What can I do?
The Pennsylvania Department of Health offers no-cost mammograms and supplemental screenings like MRI and ultrasound through its Breast and Cervical Cancer Early Detection Program (BCCEDP) for women who are uninsured or underinsured. Please contact our Director of Patient Advocacy, Dolores Magro, at 800-377-8828 ext. 3020 or Dolores@PABreastCancer.orgcreate new email to learn more. Click here to learn more about BCCEDP.
I need an MRI before this takes effect and I have a high deductible. What can I do?
If you have a high-deductible plan, you may be considered underinsured. Underinsured means you have health insurance, but it does not pay for all of your breast cancer screening or testing. The PA Department of Health’s Breast and Cervical Cancer Early Detection Program (BCCEDP) may be able to pay the part your insurance doesn’t pay. Please contact the PBCC’s Director of Patient Advocacy, Dolores Magro, at 800-377-8828 ext. 3020 or Dolores@PABreastCancer.orgcreate new email to learn more.
I still have questions. Who can I call for help?
If you are have questions about your insurance coverage, please reach out to your insurer or employer directly. For additional questions about Act 1, contact our office at 800-377-8828, email Info@PABreastCancer.orgcreate new email or call the Pennsylvania Insurance Department at 1-877-881-6388.
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